Hepatobiliary Surgery

Question 1

Post-transplant medications

Answer 1

-Anti-proliferative:
azathioprine , mycophenolic acid
-calcineurin inhibitors:
Cyclosporine , tacrolimus
-mTOR inhibitors:
sirolimus , everolimus

Question 3

Scolicidal agents

Answer 3

Hypertonic saline(15%-20%)
Povidone iodine “betadine” (10%)
H2O2
Cetrimide
Chlorohexidine
Alcohol
(Formalin shouldn’t be used)

Question 4

Lymph drainage of liver

Answer 4

-Liver except bare area———>portal LNs ———>corliac LNs
-Bare area ———>subphrenic LNs ———>posterior mediastinal LNs

Question 5

What is catirpillar anomaly?

Answer 5

RT HA passes infront or behind the CBD and CHD

Question 6

The ……………….. level is raised in cholestasis

Answer 6

Serum gamma glutamyl transpeptidase (GGT)

Question 8

What is Murphy’s sign?

Answer 8

Inspiratory arrest during deep palpation of the right upper quadrant in acute cholecystits

Question 10

Bilirubin level in choledocholithiasi

Answer 10

Between 3 and 10 mg/dL

Question 11

Because of …………… , ductal stones are visible in only 50% of cases

Answer 11

Obscuring gas in duodenum

Question 12

percutaneous transhepatic cholangiography (PTC) is important to ………….

Answer 12

-Confirm the bile duct injury
-Define billiary anatomy
-Divert billiary tree to treat leaks and can be used to stent strictures

Question 13

T2 tumors of the GB which have invaded the muscularis and treated by radical cholecystectomy that includes………..

Answer 13

GB
The GB bed of the liver
Hepato-duodenal ligament
Paraduodenal
Hepatic artery
Peri-pancreatic
Celiac LNs

Question 14

Most common complication of ERCP is …………..

Answer 14

Acute pancreatitis

Question 15

Mutations, up regulations, and genetic variants in several genes have been implicated in acute pancreatitis, namely…………..

Answer 15

Trypsinogen gene (PRSS1)
Trypsin inhibitor (SPINK1)
Cystic trans-membrane regulator (CFTR)
Endothelial ion/water channel (CLDN2) risk allele

Question 16

…………. Appear to reduce the risk of developing gallstones and thus may reduce the risk for gallstones acute pancreatitis.

Answer 16

Unsaturated fats
Coffee
Moderate alcohol consumption

Question 17

…………. , these antibiotics have a high a degree in pancreatic penetrance

Answer 17

Imipenem
Meropenem
Fluoroquinolones

Question 19

CA 19-9 mostly for…………..

Answer 19

pancreatic diseases

Question 20

CEA mostly for ………

Answer 20

Colon disease

Question 21

CA 125 mostly for…………

Answer 21

ovarian tumors

Question 22

The gold standard method for diagnosis and staging in assessment of lesions (tumors maybe) through all the pancreas is ………….

Answer 22

Multi-detector computed tomography (MDCT)

Question 23

Symptoms of somatostatinoma

Answer 23

DM
cholelithiasis
Steatorrhea
Anemia
Weight loss

Question 24

VIPoma is also called……..

Answer 24

Verner-Morrison

Question 26

What are the mesenchymal malignant tumors of the liver?

Answer 26

Angisarcoma Lymphoma

Question 27

Liver cell adenoma(LCA) can occur spontaneously or associated with………………

Answer 27

Type 1 glycogen storage disease Iron overload related to beta thalassemia DM

Question 28

What’s the best tool for diagnosis of liver cell adenoma?

Answer 28

Dynamic MRI because of its higher sensitivity for fat and hemorrhage

Question 29

The risk factors for cholangiocarcinoma

Answer 29

Primary sclerosing cholangitis Infestation with flukes (Opisthorichis or Clonorchis)

Question 30

Genes affected in klatskin cholangiocarcinoma

Answer 30

KRAS IDH1 IDH2 TP53 (for extrahepatic tumors) SMAD-4 (for extrahepatic tumors)

Question 32

What is caroli disease?

Answer 32

Intrahepatic choledochal cyst

Question 34

Complication of caroli disease

Answer 34

Intrahepatic stone formation Biliary stasis Cholangitis Cholangiocarcinoma Liver cirrhosis

Question 35

Casoni’s test (intradermal test) is done for ………….

Answer 35

Hydatid cyst